DRUG EXCRETION

DRUG EXCRETION

The process by which drugs or

metabolites are irreversibly transferred from
internal to external environment through
renal or non renal route.
Most drugs are excreted in urine either as
unchanged drugs or drug metabolites.

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 TYPES OF EXCRETION
1. RENAL EXCRETION
2. NON RENAL EXCRETION
Biliary excretion.
Pulmonary excretion.
Salivary excretion.
Mammary excretion.
Skin / Dermal excretion.
Gastrointestinal excretion.
Genital excretion.

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RENAL EXCRETION

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ANATOMY OF NEPHRON

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 Major Excretory Processes in the Nephron

1. Glomerular filtration
2. Tubular secretion
3. Tubular re-absorption
GLOMERULAR FILTRATION

It Is non selective ,
unidirectional
process
Ionized or unionized
drugs are filtered,
except those that are
bound to plasma
proteins.

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ACTIVE TUBULAR SECRETION

This mainly occurs in proximal tubule.

Active secretion is Unaffected by change in pH and
protein binding.

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PASSIVE TUBULAR REABSORPTION

most substances are reabsorbed across renal

tubular cells if unionized and lipid soluble
It occurs after the glomerular filtration of drugs.
It takes place all along the renal tubules.
Reabsorption results in increase in the half life of
the drug.

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 pH OF THE URINE

It varies between 4.5 to 7.5

It depends upon diet, drug intake and pathophysiology .

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 Acidic drugs usually contain weakly acidic functionalities,
such as COOH.
Basic drugs usually contain weakly basic functionalities,
such as amines.
Drugs which are acidic are ionized in basic media (pH > 7).
Drugs which are basic are ionized in acidic media (pH < 7)
The ionized form of the drug provides it with improved
water solubility
But the unionized form generally passes nonpolar
membranes more readily.
Acidification of urine increases reabsorption and decreases
excretion of weak acids and decreases reabsorption of
weak bases. Alkalinization of urine has the opposite effect.
In some cases of overdose, these principles are used to
enhance the excretion of weak bases or acids.
e.g. salicylate (Aspirin ) (a weak acid) overdose may be
treated by making the urine more alkaline with sodium
bicarbonate injection.
 Effect of lipid solubility and pH
Glomerular ionised drug is less lipid soluble
blood flow;
filtrate
99% of GF is re-absorbed;
concentration of drug rises in
tubule

If lipid soluble drug

moves
down concentration
gradient back into blood

Re-absorption
FACTORS AFFECTING
RENAL EXCRETION
1. Physicochemical properties of drug
Molecular size: Drugs with Mol.wt <300, water soluble are excreted in
kidney. Mol.wt 300 to 500 Dalton are excreted both through urine and
bile.
Binding characteristics of the drug: Drugs that are bound to plasma
proteins behave as macromolecules and cannot be filtered through
glomerulus. Only unbound or free drug appear in glomerular filtrate.
Protein bound drug has long half lives.
2. Biological factor: Age, sex
3. Drug interaction: increase or decrease
4. Disease state Urine pH: RF
5. Blood flow to the kidney 13
NON-RENAL ROUTE OF DRUG
EXCRETION
Various routes are
Biliary Excretion
Pulmonary Excretion
Salivary Excretion
Mammary Excretion
Skin/dermal Excretion
Gastrointestinal Excretion
Genital Excretion
 PULMONARY EXCRETION

Gaseous and volatile substances such as general anesthetics

(Halothane) are absorbed through lungs by simple diffusion.
Pulmonary blood flow, rate of respiration and solubility of
substance effect PE. Intact gaseous drugs are excreted but not
metabolites. Alcohol which has high solubility in blood and tissues
are excreted slowly by lungs.
 SALIVARY EXCRETION

The pH of saliva varies from 5.8 to 8.4. Unionized lipid

soluble drugs are excreted passively.
The bitter after taste in the mouth of a patient is

indication of drug excreted.

Some basic drugs inhibit saliva secretion and are
responsible for mouth dryness.
Compounds excreted in saliva are Caffeine, Phenytoin,

Theophylline.
 MAMMARY EXCRETION
Milk consists of lactic secretions which is rich in fats
and proteins.

Excretion of drug in milk is important as it gains entry in

breast feeding infants.

pH of milk varies from 6.4 to 7.6. Free un-ionized and

lipid soluble drugs diffuse passively..
SKIN EXCRETION
Drugs excreted through skin via sweat

may lead to urticaria and dermatitis.

Compounds like benzoic acid, salicylic acid,

alcohol and heavy metals like lead, mercury and
arsenic are excreted in sweat.

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 GASTROINTESTINAL EXCRETION
Excretion of drugs through GIT usually
occurs after parenteral administration. Water
soluble and ionized from of weakly acidic and
basic drugs are excreted in GIT. Example are
nicotine and quinine are excreted in stomach.
Drugs excreted in GIT are reabsorbed into
systemic circulation & undergo recycling.